CORREÇÃO ENDOVASCULAR DE ANEURISMAS: STATUS ATUAL NAS ESPECIFICAÇÕES E RESULTADOS DAS ENDOPRÓTESES
DOI:
https://doi.org/10.48750/acv.135Palavras-chave:
Aneurisma da aorta abdominal, Correção endovascular de aneurismas da aorta abdominal, endopróteseResumo
Introdução: Desde a sua introdução, em 1991, o tratamento endovascular (EVAR) tornou-se o método de eleição na correção dos aneurismas da aorta abdominal (AAA). Inúmeros dispositivos foram produzidos, desde então, abrangendo anatomias cada vez mais complexas. O objetivo desta revisão é proporcionar uma atualização nas endopróteses disponíveis e comparar os seus resultados.
Materiais e Métodos: Foi realizada uma pesquisa, nas bases de dados da MEDLINE, sobre características das endopróteses e respetivos resultados.
Resultados: Atualmente, existe uma grande variedade de endopróteses aprovada com propriedades anatómicas distintas. Existem seis próteses com aprovação CE e FDA: Zenith®, AFX®, C3 EXCLUDER®, Endurant® II, Ovation® e Aorfix™; e seis com a aprovação CE: Anaconda™, E-vita ABDOMINAL XT®, E-tegra®, Incraft®, TREOVANCE® e Altura™. Existem, ainda, quatro próteses fenestradas e ramificadas disponíveis para o tratamento de aneurismas toracoabdominais: Zenith® Fenestrated, Fenestrated Anaconda™, Zenith® p-Branch® and Zenith® t-Branch®. As endopróteses Endurant II e Treovance acomodam colos aórticos ≥10 mm; Aorfix e Anaconda são mais flexíveis no que respeita à angulação, permitindo que o ângulo aórtico se estenda até 90º. Por fim, as próteses Zenith, C3 Excluder, Ovation e Incraft podem ser usadas em locais de fixação distal com comprimento ≥10 mm.
Conclusão: As próteses de nova geração têm um melhor desempenho que as mais ancestrais, especialmente no que diz respeito a anatomias complicadas. Os resultados a médio prazo entre as próteses contemporâneas assemelham-se para a maioria das variáveis. Contudo, não existem estudos controlados randomizados comparativos entre as diferentes endopróteses, dificultando a obtenção de conclusões. São necessárias revisões de longo prazo para assumir, assertivamente, pressupostos acerca do desempenho das diferentes próteses.
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13. Eckroth-Bernard K, Garvin R, Ryer E. Current status of endovascular
devices to treat abdominal aortic aneurysms. Biomed Eng
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14. Bergonti M, Teruzzi G, Santagostino G, Grancini L, Ferrari C,
Trabattoni D, et al. Third- versus Second-Generation Stent Graft
for Endovascular Aneurysm Repair: A Device-Specific
Analysis. Annals of Vascular Surgery. 2017.
15. Katsargyris A, Mufty H, Wojs R, Utech G, Verhoeven EL. Single-
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in 200 consecutive patients. J Cardiovasc Surg (Torino).
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16. Michael M. McNally SLS. The story of evolution of endovascular
aneurysm repair and the Gore Excluder Device. Supplement to
Endovascular Today. 2017;16(3):4.
17. Carpenter JP, Baum RA, Barker CF, Golden MA, Mitchell ME, Velazquez
OC, et al. Impact of exclusion criteria on patient selection
for endovascular abdominal aortic aneurysm repair. J Vasc Surg.
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18. Sirignano P, Mansour W, Pranteda C, Siani A, Accrocca F, d’Adamo
A, et al. Real life experience with Ovation stent-graft: lesson
learned from first hundred-fifty treated patients. Annals of
Vascular Surgery. 2017.
19. Perdikides T, Georgiadis GS, Avgerinos ED, Fotis T, Verikokos
C, Hopkinson BR, et al. The Aorfix stent-graft to treat infrarenal
abdominal aortic aneurysms with angulated necks and/
or tortuous iliac arteries: midterm results. J Endovasc Ther.
2009;16(5):567-76.
20. Rodel SG, Geelkerken RH, Prescott RJ, Florek HJ, Kasprzak P,
Brunkwall J, et al. The Anaconda AAA stent graft system: 2-year
clinical and technical results of a multicentre clinical evaluation.
Eur J Vasc Endovasc Surg. 2009;38(6):732-40.
21. Rodel SG, Zeebregts CJ, Huisman AB, Geelkerken RH, Multicenter
Angulated Neck Study with the Anaconda study p. Results
of the Anaconda endovascular graft in abdominal aortic
aneurysm with a severe angulated infrarenal neck. J Vasc Surg.
2014;59(6):1495-501, 501 e1.
22. Scheinert D, Pratesi C, Chiesa R, Coppi G, Brunkwall JS, Klarenbeek
G, et al. First-in-human study of the INCRAFT endograft in
patients with infrarenal abdominal aortic aneurysms in the INNOVATION
trial. J Vasc Surg. 2013;57(4):906-14.
23. Sugimoto M, Torsello GF, Torsello GB, Austermann M, Stachmann
A, Bisdas T. Postmarket Clinical Experience with the INCRAFT
AAA Stent Graft System for Challenging Access Routes. Ann
Vasc Surg. 2017;40:120-7.
24. Chiesa R, Riambau V, Coppi G, Zipfel B, Llagostera S, Marone EM, et
al. The Bolton Treovance abdominal stent-graft: European clinical
trial design. J Cardiovasc Surg (Torino). 2012;53(5):595-604.
25. Rylski B, Czerny M, Sudkamp M, Russe M, Siep M, Beyersdorf
F. Fenestrated and Branched Aortic Grafts. Dtsch Arztebl Int.
2015;112(48):816-22.
26. Graves HL, Jackson BM. The Current State of Fenestrated and
Branched Devices for Abdominal Aortic Aneurysm Repair. Semin
Intervent Radiol. 2015;32(3):304-10.
27. Oderich GS, Correa MP, Mendes BC. Technical aspects of repair of
juxtarenal abdominal aortic aneurysms using the Zenith fenestrated
endovascular stent graft. J Vasc Surg. 2014;59(5):1456-61.
28. Bungay PM, Burfitt N, Sritharan K, Muir L, Khan SL, De Nunzio MC,
et al. Initial experience with a new fenestrated stent graft. J Vasc
Surg. 2011;54(6):1832-8.
29. Bakoyiannis CN, Economopoulos KP, Georgopoulos S, Klonaris C,
Shialarou M, Kafeza M, et al. Fenestrated and branched endografts
for the treatment of thoracoabdominal aortic aneurysms: a
systematic review. J Endovasc Ther. 2010;17(2):201-9.
30. Shahverdyan R, Gray D, Gawenda M, Brunkwall J. Technical feasibility
of endovascular aortoiliac aneurysm repair combining
Anaconda fenestrated and Zenith iliac side-branched stent
grafts. J Vasc Surg. 2015;61(5):1324-8.
31. Rolls AE, Jenkins M, Bicknell CD, Riga CV, Cheshire NJ, Burfitt N, et
al. Experience with a novel custom-made fenestrated stent graft
in the repair of juxtarenal and type IV thoracoabdominal aneurysms.
J Vasc Surg. 2014;59(3):615-22.
32. Dijkstra ML, Tielliu IF, Meerwaldt R, Pierie M, van Brussel
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2018-06-07
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Cordeiro F, Oliveira-Pinto J, Mansilha A. CORREÇÃO ENDOVASCULAR DE ANEURISMAS: STATUS ATUAL NAS ESPECIFICAÇÕES E RESULTADOS DAS ENDOPRÓTESES. Angiol Cir Vasc [Internet]. 7 de Junho de 2018 [citado 24 de Novembro de 2024];14(2):121-32. Disponível em: https://acvjournal.com/index.php/acv/article/view/135
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